Orthopedic Surgery

Early-onset Scoliosis

More than 100,000 children in the U.S. are diagnosed with scoliosis each year. The majority of these children are diagnosed between the ages of 10 and 15 with adolescent idiopathic scoliosis.

Identifying idiopathic scoliosis at birth or in early childhood is rare. The type of scoliosis is generally categorized by age at onset of diagnosis:

Early-onset scoliosis is a subset of idiopathic scoliosis, and has no known cause. But unlike idiopathic scoliosis, which can be a singular spinal condition, early-onset scoliosis is often accompanied by other health issues, such as chest wall deformities, neuromuscular diseases such as spina bifida or cerebral palsy, and other factors such as benign or malignant spinal tumors.

Because of the complex issues surrounding early-onset scoliosis, children with this disorder need to be treated by expert clinicians who are part of a multidisciplinary team that has significant experience treating this rare disorder.

The Children’s Hospital of Philadelphia is ranked No. 1 in the nation for pediatric orthopedics, according to U.S.News & World Report’s 2012-13 rankings of the Best Children’s Hospitals. The Division of Orthopedic Surgery at CHOP offers comprehensive evaluation and treatment for children with all forms of scoliosis and performs more than 3,000 orthopedic surgeries a year.

This page will help you better understand the symptoms, treatment and care for children with early-onset scoliosis.

Symptoms of early-onset scoliosis

The most common symptoms of early-onset scoliosis are:

Evaluation and diagnosis of early-onset scoliosis

Prompt diagnosis of early-onset scoliosis is important for successful treatment of spinal curves and optimal long-term results for children. A physician will perform a complete medical history, physical examination and visual evaluation of the curvature of your child's spine.

Imaging tests take a closer look at the spine to see if there are any problems with the bones and to measure what degree of curvature is present. X-rays are the primary diagnostic tool for early-onset scoliosis and demonstrate the precise angles of curvature.

If the curve pattern is not typical or if there is something unusual in the X-ray, a physician may order one of the following tests to provide more information:

Additionally, if your child has other associated health issues, a physician may order other examinations or consultations with experts from cardiology, pulmonology, nephrology or other specialties.

Individualized and collaborative treatment

Some children with early-onset scoliosis do not require treatment; their condition may not worsen or may correct itself as they grow. Other children with progressive curves may need immediate treatment to prevent chest wall deformity and allow normal lung development.

Close monitoring of all children with early-onset scoliosis can determine which treatment path is best for each individual child.

At The Children’s Hospital of Philadelphia, we practice collaborative, family-centered care. A team of expert clinicians — including leading orthopedic physicians and surgeons, pediatric nurses, physical and occupational therapists, psychologists, and other specialists — partner with you in the care of your child.

In planning your child's individual treatment, our team of specialists will consider the severity of the curve, where it occurs in the spine, your child's age and stage of growth, as well as your child’s other health conditions.

Nonsurgical interventions

Some patients with early-onset scoliosis do well without surgery and may only need to be monitored regularly by a physician to ensure the curve doesn't worsen. Monitoring may include regular observation, X-rays and lab tests.

For children with spinal curves less than 40 degrees, doctors may prescribe a spine brace as treatment — at least temporarily.

The brace will reduce pressure on your child's lower back and help straighten his spine. It should be worn most of the time for optimal results. 

Spine bracing may be recommended as treatment for early-onset scoliosis or as a medical aid leading up to or immediately after spine surgery.

Surgical interventions

For children with spinal curves of 40 degrees or greater, spinal surgery is almost always indicated.

Surgery can dramatically improve early-onset scoliosis, but can also be a stressful experience for both child and parent. At CHOP, we offer a wealth of resources to prepare your child for surgery, know what to expect during surgery and understand specific ways we make safety in surgery a top priority.

The most common surgical treatments for early-onset scoliosis are implanting growing rods or vertical expandable prosthetic titanium ribs (VEPTR). Both devices permit continued spine growth, maximize the space available for lung growth and enhance pulmonary function.

The determination of which surgery is right for your child will depend on your child's age, skeletal maturity and other health considerations. Each patient is evaluated individually, and treatment is suggested based on your child’s long-term health needs.

Growing rods

In growing rod surgery, the curve in your child's back is spanned by one or two rods under the skin to avoid damaging the growth tissue of the spine. The rods are attached to your child’s spine and vertebrae above and below the curve. The growing rods help guide spinal growth and drive the spine straight.

As your child grows, he will return to the Hospital every six months for outpatient surgery to have the growing rods expanded. This approach minimizes the spinal deformity, maximizes spine growth and allows continued lung development as the child grows.

Vertical expandable prosthetic titanium ribs (VEPTR)

Like growing rods, the VEPTR allows continued spine growth and enhances pulmonary function. Developed by Robert M. Campbell Jr., MD, one of CHOP’s leading orthopedic surgeons, VEPTR is the most advanced treatment option for children with thoracic insufficiency syndrome, a rare condition.

Children with thoracic insufficiency syndrome have severe deformities of the chest, spine and ribs that prevent normal breathing and lung development.

VEPTR straightens the spine, but also expands the space available for the lungs and other internal organs to grow. VEPTR devices can be attached to your child’s spine, rib, pelvis or collar bone, and multiple devices can be implanted depending on your child’s individual needs.

Like growing rods, VEPTR is surgically adjusted as your child ages and reaches full skeletal maturity.

Another option: spinal fusion

Spinal fusion is generally not recommended as an initial treatment for early-onset scoliosis in younger children. In a spinal fusion, the abnormal curved spinal bones are realigned and fused together and metal implants are inserted to correct the curvature.

Spinal fusion will effectively stop the growth of the child’s spine.

The results of spinal fusion are much more positive if the surgery is performed after your child has reached skeletal maturity. For adolescents who have achieved normal lung capacity before scoliosis curves worsened, spinal fusion can improve their quality of life and life expectancy.

Follow-up care for early-onset scoliosis 

If spine bracing was recommended for your child, he or she will be re-evaluated every six months until the condition is stable. If bracing was recommended as a treatment leading up to spinal surgery, your child will be evaluated regularly before and after surgery until your child's condition is stable. After the spine is stabilized, annual visits to an orthopedic healthcare provider are recommended. 

If your child received growing rods or VEPTR, an additional surgery — spinal fusion — may be recommended when your child has finished growing.

After treatment — whether surgical or nonsurgical — the clinical team at CHOP will continue to follow-up on your child's care at our Main Campus or one of our CHOP Care Network locations.

We recognize that your child's pediatrician is an important part of the clinical team and provide regular updates on your child's progress. If continued care and monitoring is necessary, we will help transition your child's care to an adult orthopedic team.

Long-term outcomes for early-onset scoliosis

The prognosis for patients with early-onset scoliosis has improved significantly during the past 10 years. Children who are treated for other disorders, in addition to the spinal deformity, may need long-term care into adulthood.

Your clinical team at The Children's Hospital of Philadelphia is available to help transition your child to an adult care team, if necessary, to ensure his or her continued health.

Resources

At The Children's Hospital of Philadelphia, we offer a wealth of ongoing support and services for patients and their families. Our team is committed to partnering with parents and other caregivers to provide the most current, comprehensive and specialized care possible for your child. Below are some additional resources that may be helpful if your child has been diagnosed with early-onset scoliosis.

Contact us

To make an appointment with the Division of Orthopedic Surgery at The Children's Hospital of Philadelphia, call 215-590-1527 or contact us online.

Reviewed by: Jason Katz, PA, and John P. Dormans, MD, FACS
Date: January 2013

  • Print
  • Share

Contact Us